仰卧位与侧卧位下股骨近端髓内钉对老年股骨粗隆间骨折患者疗效的影响

The supine position and lateral position of PFNA in elderly patients with femoral intertrochanteric fracture curative effect

目的探讨仰卧位与侧卧位下行股骨近端髓内钉(PFNA)对老年股骨粗隆间骨折患者疗效的影响,为术中体位选择提供依据。方法选取2009年4月至2014年4月收治的115例股骨粗隆间骨折老年患者,均实施PFNA治疗。按照患者意愿纳入仰卧位与侧卧位组,分别实施仰卧位牵引床牵引与侧卧位徒手牵引。比较两组患者手术情况及髋关节功能变化,评价疗效。结果侧卧位组手术时间、切口长度、术中出血量、负重时间显著低于仰卧位组(P<0.05)。仰卧位组出现3例术后并发症(4.3%),侧卧位组出现2例术后并发症(4.3%)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。两组患者术后1个月、6个月及1年髋关节Harris评分均较术前显著升高,侧卧位组升高更为明显(P<0.05)。末次随访时仰卧位组优良率88.4%,侧卧位组优良率93.5%。两组患者优良率比较差异无统计学意义(P>0.05)。结论仰卧位与侧卧位下行PFNA治疗老年股骨粗隆间骨折均可达到较好的效果,但侧卧位下手术具有操作简便、手术时间短、出血量少、恢复快等优势。

Objective To investigate the supine position and lateral position downstream of Proximal femoral nail antirotation（ PFNA） of patients with intertrochanteric fracture of femur in the elderly,provide the basis for the selection of position during operation. Methods 115 cases of femoral intertrochanteric fracture 2009 April to 2014 year in April in elderly patients were treated with PFNA. According to the wishes of patients,all these patients were divided into the supine position and lateral position group,respectively. All these patients were performed the supine traction and lateral position manual traction. The changes were compared between the two groups of operation and the function of hip joint,evaluation of curative effect. Results The operation time,incision length,intraoperative blood loss,weight bearing time of the lateral position group was significantly lower than that in supine position group（ P〈0. 05）. The postoperative complications occurred in 3 patients（ 4. 3%） of the supine position group,lateral position group with postoperative complications in 2 patients（ 4. 3%）. The postoperative complication rate of the two groups of patients were no significant difference（ P〉0. 05）. The two groups of patients after 1 months,6 months and 1 years of Harris hip score were significantly higher than those before the operation,lateral position group increased more significantly（ P〈0. 05）. At the last follow- up supine position group the excellent and good rate was 88. 4%,the excellent and good rate was 93. 5% in the lateral decubitus position. The excellent and good rate of two groups of patients were significant differences（ P〈0. 05）. Conclusion The supine position and lateral position downstream of PFNA in treatment of intertrochanteric fracture of femur in the elderly can achieve better effect,lateral position surgery has the advantages of simple operation,short operation time,less bleeding,rapid recovery and other advantages,is worth popularizing widely.